Cost-effectiveness of 10-kHz Spinal Cord Stimulation Therapy Compared With Conventional Medical Management Over the First 12 Months of Therapy for Patients With Nonsurgical Back Pain: Randomized Controlled Trial
Objective: This analysis evaluated if spinal cord stimulation (SCS) at 10 kHz plus conventional medical management (CMM) is cost-effective compared with CMM alone for the treatment of nonsurgical refractory back pain (NSRBP).
Methods: NSRBP subjects were randomized 1:1 into the 10-kHz SCS (n = 83) or CMM (n = 76) group. Outcomes assessed at 6 months included EQ-5D 5-level (EQ-5D-5L), medication usage, and healthcare utilization (HCU). There was an optional crossover at 6 months and follow-up to 12 months. The incremental cost-effectiveness ratio (ICER) was calculated with cost including all HCU and medications except for the initial device and implant procedure, and cost-effectiveness was analyzed based on a willingness-to-pay threshold of < $50,000 per quality-adjusted life-year.
Results: Treatment with 10-kHz SCS resulted in a significant improvement in quality of life (QOL) over CMM (EQ-5D-5L index score change of 0.201 vs -0.042, p < 0.001) at a lower cost, based on reduced frequency of HCU resulting in an ICER of -$4964 at 12 months. The ICER was -$8620 comparing the 6 months on CMM with postcrossover on 10-kHz SCS.
Conclusions: Treatment with 10-kHz SCS provides higher QOL at a lower average cost per patient compared with CMM. Assuming an average reimbursement for device and procedure, 10-kHz SCS therapy is predicted to be cost-effective for the treatment of NSRBP compared with CMM within 2.1 years.
Patel, Naresh P; Wu, Chengyuan; Lad, Shivanand P; Jameson, Jessica; Kosek, Peter; Sayed, Dawood; Waldorff, Erik I; Shum, Laura C; Province-Azalde, Rose; and Kapural, Leonardo, "Cost-effectiveness of 10-kHz Spinal Cord Stimulation Therapy Compared With Conventional Medical Management Over the First 12 Months of Therapy for Patients With Nonsurgical Back Pain: Randomized Controlled Trial" (2023). Department of Radiology Faculty Papers. Paper 141.
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This article is the author’s final published version in Journal of Neurosurgery: Spine, Volume 38, Issue 2, February 2023, Pages 249 - 257.
The published version is available at https://doi.org/10.3171/2022.9.SPINE22416. Copyright © Patel et al.